Dental auxiliaries versus community health workers: similarities and contrasts

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1 REVISTA DE ODONTOLOGIA DA UNESP ORIGINAL ARTICLE Rev Odontol UNESP Set-Oct; 42(5): ISSN Dental auxiliaries versus community health workers: similarities and contrasts Profissionais auxiliares da odontologia versus agente comunitário de saúde: similaridades e contrastes Simone de Melo COSTA a, Flávia Ferreira ARAÚJO a a UNIMONTES Universidade Estadual de Montes Claros, Montes Claros, MG, Brasil Resumo Introdução: Os rofissionais auxiliares da odontologia e os agentes comunitários de saúde (ACS s) são rofissionais que reresentam imortante segmento na Estratégia Saúde da Família e ossuem funções diversificadas. Objetivo: Analisar as atribuições dos auxiliares de cirurgiões-dentistas e dos agentes comunitários de saúde, tanto no asecto da utilização de seus serviços como na formação, identificando as similaridades e contrastes entre os rofissionais da saúde da família, Brasil. Metodologia: Estudo quantitativo e censitário conduzido no âmbito do Programa de Educação elo Trabalho em Saúde- PET-Saúde, O instrumento de coleta de dados foi um questionário semiestruturado. A análise considerou o nível de significância <0,05. Resultado: Particiaram 29 rofissionais auxiliares da odontologia e 241 ACS s. As funções relacionadas ao contexto comunitário, como conhecer as condições de saúde do território, identificar situação de risco das famílias, visita domiciliar estiveram mais associadas ao ACS s (<0,05). Em contraste, atividades no ambiente clínico como auxiliar rofissional de nível suerior e realizar rocedimentos clínicos são ações redominantemente dos técnicos/auxiliares da odontologia (<0,05). As categorias rofissionais aresentaram similaridades na rática de vigilância à saúde, reflexão do trabalho em equie e educação e mobilidade comunitária (>0,05). Conclusão: Similaridades e contrastes foram identificados entre as ações dos rofissionais. A categoria auxiliar em odontologia, aesar de funções esecíficas no ambiente clínico, ao integrar-se à equie saúde da família reorienta a rática rofissional assumindo ações no âmbito coletivo e familiar. Descritores: Pessoal técnico de saúde; auxiliares de odontologia; agentes comunitários de saúde; saúde da família; rática rofissional. Abstract Introduction: The dental auxiliaries and the community health workers (CHWs) are ractitioners that reresent an imortant art in the Family Health Policy in Brazil and have several tasks. Objective: To analyze the attributes of the dental auxiliaries and of the CHWs, regarding the alication of their services and their education/training, to identify the similarities and contrasts between these health care ractitioners. Methodology: Quantitative and census method data collection erformed on the context of the Education Program for Health Workers - PET Saúde, The data collection method was a semi-structured questionnaire. The analysis has a level of significance of <0.05. Result: In this aer, 29 dental auxiliaries and 241 CHWs have articiated in the surveys. The assignments that take lace on the community context, such as home visits were more associated to the CHWs (<0.05). On the other hand, the activities that haen on a clinical environment, such as roviding assistance to graduated health rofessionals and erforming clinical rocedures, are more commonly erformed by the dental assistant (<0.05). Both categories resented similarities erforming reventive health care, teamwork analysis, informative initiatives and community mobilization routines (>0.05). Conclusion: Similarities and contrasts were identified between these health care workers. The dental auxiliaries, desite being mostly issued to secific assignments on a clinical environment, are able to shift their raxis by taking actions on a family and community context once integrated to a family health team. Descritors: Allied health ersonnel; dental auxiliaries; community health workers; family health; rofessional ractice.

2 Rev Odontol UNESP. 2013; 42(5): Dental auxiliaries versus community health workers 351 INTRODUCTION The Family Health Strategy (Estratégia Saúde da Família - ESF) resents itself as a roosal to restructure the Primary Health Care (PHC) in Brazil, by following the directives of the Brazilian Unified Health System (Sistema Único de Saúde - SUS). The ESF aims to rovide continuous and integral health assistance to the community surrounding the Basic Health Care Unit, according to the needs of the oulation 1. The ESF team is multi-rofessional and must act as such. It consists of hysicians, nurses, nursing assistants, community health workers (CHWs) and, since the year 2000, it also rallies dentists, dental technicians and oral health assistants 2,3. The dentistry workers develo reventive actions regarding oral diseases and health romotion routines 4. The erformance of these rofessionals has been a success factor for the oeration of the health care teams 5. Even though comarative studies between the roles of the ESF workers are imortant, they have been overlooked by researchers. The comarison of the roles of the CHWs with those of other health workers may be useful, given the community health worker (CHW) were molded by the family health care olicies in Brazil. A recent study 6, erformed with the same subjects of the resent aer, has identified the roles of the CHW on a family health care environment. In the resent aer, their tasks are comared to those of the dental auxiliaries. The hyothesis of this study is that many of the tasks of the CHW were also undertaken by dental auxiliaries, desite their role being consolidated in a clinical setting and under the suervision of graduated health rofessionals. It is believed that a new set of skills had to be attained by the dental rofessionals in order to act in a family health care setting. Therefore, discussing the work assignments in the ESF is timely and necessary, as it may contribute to the develoment of strategies that address the challenges regarding the qualifications of the PHC. This study examined the tasks of dental auxiliaries and community health agents, both in the usage of their services as in their training, identifying similarities and contrasts between these family health workers. METHODOLOGY Quantitative, observational and cross-sectional study made under the Education Program for Health Workers PET-Saúde of the Universidade Estadual de Montes Claros, Notice. The roosal had census directed and was develoed with CHWs and dental auxiliaries (dental assistants- DAs and dental hygienist- DHs) associated to the ESF in the urban area of Montes Claros city, located in the state of Minas Gerais, Brazil. The aforementioned city is considered a regional urban center of the northern ortion of the state, with an estimated oulation of 361,971,000 inhabitants. The instrument for data collection was a semi-structured, self-reort questionnaire filled by 270 family health workers (241 CHWs and 29 dental auxiliaries). The questionnaire was designed to meet the objectives of the study and derived from bibliograhic research on the subject. A ilot study was erformed with only 10 articiants to test and adat the data collection instrument. These subjects were not included in the main study. The actual data collection occurred between the months of August and October of the year Statistical analysis was erformed using SPSS comuter rogram, version 18.0 (SPSS Inc., Chicago, USA). The descritive analysis involved the calculation of measures of central tendency of searatrices and of roortions. To make comarisons between the work categories, Pearson s chi-squared test was used and Fisher Test and Student s T-Test were laced as alternatives. The level of significance considered was <0.05 with a 95% confidence interval. The study was aroved by the Health Secretary of Montes Claros and by the Ethics Committee in Research (Protocol #1966/2010), in accordance with the Helsinki Declaration and the Resolution of 196/96 of the National Health Council. All the data obtained is confidential. RESULT A total of 270 health workers were art of the resent study, while 29 of those were dental auxiliaries (10.7%). The female gender has been dominant on both categories, being absolute on the dental assistant grou (100%), with a statistical difference (<0.05). The dental auxiliaries resented higher age average, set at years old (± 9.920) (<0.001). They also resent longer average exerience on the ublic sector, set at 6.42 years (±5.72) (=0.054) (Table 1). Regarding rofessional certification, the dental auxiliaries reorted having taken more courses related to their occuation (93.1%) than the CHWs (=0.005). Most of the dental auxiliaries believe they are ready to work on SUS (96.6%), with no statistical difference between these health workers grous (>0.05) (Table 2). With regard to actions relating to the context of family health workers, the dental auxiliaries (82.8%) have reorted being aware of the health condition of the oulation in their work area, though resenting a lower ercentage than that of the CHWs category (<0.001). Regarding roviding information to the family health care team on the situation of the families served, the dental auxiliaries showed lower ercentage of ositive resonse in comarison to the CHWs (<0.001). The referral of eole to graduated medical rofessionals is also done at a lower rate by the dental auxiliaries (82.1%) (=0.083). Most of the dental auxiliaries (89.7%) reorted allocating some of their time for ersonal analysis related to their teamwork skills, with no statistical difference between the categories analyzed (>0.05) (Table 3). By assessing collective tasks in family health, it has been found that the dental auxiliaries erform home visits (89.3%) at a lower rate than the CHW do (<0.001). Most of the dental auxiliaries do not make a record of the families (82.1%), unlike the CHWs ( <0.001). The identification of families under health risk was a task associated with the CHWs, although the dental

3 352 Costa, Araújo Rev Odontol UNESP. 2013; 42(5): auxiliaries also rovide a significant ortion (58.6%) (<0.001). Dental auxiliaries refer families to health care services (93.1%), however, such task was associated with the CHWs (<0.05). The erformance of educational and health awareness activities was detected in both health work categories (>0.05). The romotion of education and community mobilization was observed in lower revalence in the dental auxiliaries category (<0.05) (Table 4). The tasks erformed on a clinical setting in the ESF environment were evaluated by the health worker categories. Dental auxiliaries aid graduated health rofessionals (93.1%), Table 1. Social and Demograhic rofile of the study subjects Subjects of the resent study Community Health Workers Dental Auxiliaries Gender Female 79.3% 100.0% =0.008 Male 20.7% 0.0% Average age (standard deviation) (±7.787) (± 9,920) <0.001 Average time working on the ublic sector (standard deviation) 5.08 (±3.179) 6.42 (±5.72) =0.054 Table 2. Professional Certification Professional certification and SUS Community Health Workers Dental Auxiliaries Certification on their occuation Yes 68.0% 93.1% =0.005 No 32.0% 6.9% Course taken related to their occuation Yes 97.9% 93.1% =0.124 No 2.1% 6.9% Ready for SUS Yes 94.6% 96.6% =0.652 No 5.4% 3.4% Table 3. Distribution of tasks of the health care workers erformed under a Family Health Care setting Family health care setting Community Health Workers Dental Auxiliaries Awareness of the ESF health conditions Yes 97.5% 82.8% <0.001 No 2.5% 17.2% Reorts health condition of the families to the team Yes 99.2% 79.3% <0.001 No 0.8% 20.7% Referrals eole to medical graduated rofessionals Yes 92.1% 82.1% =0.083 No 7.9% 17.9% Self-analysis of teamwork along ESF Yes 82.4% 89.7% =0.321 No 17.6% 10.3%

4 Rev Odontol UNESP. 2013; 42(5): Dental auxiliaries versus community health workers 353 Table 4. Grou tasks erformed by Family Health Care workers Grou tasks erformed by family health care workers Community Health Workers Dental Auxiliaries Home visiting Yes 99.6% 89.7% <0.001 No 0.4% 10.3% Family record Yes 99.2% 17.9% <0.001 No 0.8% 82.1% Identification of families under health risk Yes 99.2% 58.6% <0.001 No 0.8% 41.4% Family instructing Yes 99.6% 93.1% =0.002 No 0.4% 6.9% Health awareness tasks erformed Yes 86.3% 96.6% =1.115 No 13.7% 3.4% Community education and mobilization Yes 71.8% 55.2% =0.064 No 28.2% 44.8% erform clinical rocedures on atients (34.5%) and erform disinfection and sterilization routines (93.1%). On the other hand, most of the CHWs do not ractice such tasks (<0.001) (Table 5). DISCUSSION The resent study was erformed with a greater number of CHWs. This is due to the fact that the CHW is art of the family health team, as dictated by the ESF. Each team may have u to 12 CHWs 7. The majority of the articiating health workers were female, and 100% of the dental auxiliaries were women. Such fact is in accord to other studies focused on dental auxiliaries The dental auxiliaries have dislayed higher average age. This can be artially exlained by the fact that CHW is a recent occuation in Brazil. Desite existing since 1991 through the Programa de Agentes Comunitários de Saúde (PACS), this occuation was effectively regulated only in 2002, by law nº Regarding the dental auxiliaries, their occuation exists since the 70 s 14, though it has only been regulated on December 2008 by law nº The average time working for the ublic sector was also higher for the dental auxiliaries (=0.05) what can be exlained by the longer existence of such occuation. Most subjects claimed being certificated on their field of work, and the dental auxiliaries reorted taking more courses. To become a CHW, the Brazilian Ministry of Health (Ministério da Saúde - MS) requires basic education, as it is defined by the law nº which regulates the occuation 16. A secific CHW certification course is available since 2004, though it is not mandatory, which may exlain why some CHWs reort not having taken any courses 17,18. On the other hand, DAs or DHs must fully take a theoretical/ractical course to be certified to work. In the resent aer, both categories claimed being art of in in-service training, as well as taking time self-analyze their teamwork erformance on the ESF environment. The training includes rearation to work following guidelines that organize work and integrate the family health team members 19. It is imortant that these workers undergo continuous training, as established by the guidelines of SUS. A roerly reared health worker can better fulfill their tasks in order to meet the needs brought about by the dynamism of roblems 20. Besides allowing for rofessional develoment, this continuous training is an imortant mechanism in the develoment of the concet of a team formed by workers in touch with the oulation this trait is fundamental for the oeration of the ESF 21. Regulation nº 1886/GM, created by the Ministry of Health requires the CHWs to receive in-service training, in a gradual and continuous manner, under the resonsibility of their Instructor- Suervisor, considering the riorities identified on the area of

5 354 Costa, Araújo Rev Odontol UNESP. 2013; 42(5): Table 5. Tasks erformed on a clinical environment Tasks erformed on the clinical environment of the ESF Unit Community Health Workers Dental Auxiliaries Aids rofessionals on a clinical setting Yes 33.6% 93.1% <0.001 No 66.4% 6.9% Performs clinical rocedures Yes 9.2% 34.5% <0.001 No 90.8% 65.5% Performs disinfection and sterilization Yes 3.8% 93.1% <0.001 No 96.2% 6.9% work 21. Regarding the DAs and DHs, the in-service training is imortant, given the ESF resents new challenges to these workers since they are no longer restricted to a clinical setting. On the subject of taking time to self-analyze their work, the Ministry of Health has ublished olicies aimed at the rearation and develoment for SUS. This document establishes that from the analyses of the teamwork, taking into account the knowledge and exerience of the workers, it is ossible to identify and craft strategies that tackle issues that emerge on a daily basis at health work 22. The ongoing training comoses fundamental strategies to the transformations of work, given it allows for critical analysis, exeriences exchange and resolution of roblems aimed at imroving the work setting 23,24. This ongoing education identified on the ESF environment may have, at least artially, contributed to the common feeling of readiness for the tasks required at SUS, this confidence has been noted on a large ortion of both worker categories. The awareness of the health conditions of the oulation living in the area of work as reorting the situation of the families under the care of the ESF to the team were tasks erformed by the majority of the members from both grous, though being more commonly erformed by the CHWs (<0.001). As for the referral of eole to clinical attention, this task was erformed by both grous, with no relevant differences resent (>0.05). The community health agent is the link between the health services user and the health care team, since the lanning of the health care work is derived from what is reorted to the CHWs by the oulation. The CHW acts as a social medium that translates the actual needs of the community to the health team and ensures that the grou identity of the eole under its resonsibility are in harmony with the health activities erformed by the health ublic service 25. In this fashion, the CHW acknowledges the health situation of the community and is able to identify the families that require greater care by the ESF. Additionally, the CHW scouts roblems of the area of work that are relevant to the health ersonnel and may require some kind of intervention, such as oen sewage, laces teeming with infections and contagious diseases, among others 26. On the resent aer, most of the subjects erform home visitations, though on a smaller scale by the dental auxiliaries. This task is an imortant instrument of intervention utilized by the health times, since it allows for bonding with the family under care and favors the understanding on the dynamics of said family 27. In this manner, and by understanding the family relations as a relevant asect to the hysical condition of the eole 28, the home visitation allows the rofessionals to lan their actions, by taking into consideration the lifestyle and the available resources of the families 27. In Brazil, the Ministry of Health has recognized home visitation as the main instrument of the CHWs 12. Through it, the CHW identifies families that requires secial care, erforms tasks towards the integration of the health team and the oulation under its care and erform educational health initiatives. The health team must know the actuality of the families to otimize their work. Thus, the team must gather information that oint to the main health needs of the oulation, erforming a large scale diagnosis on the entire community, necessary for crafting a lan of action 29. Therefore, the CHWs may increase the access to health care and allow for the adequate usage of health care resources, triage, detection and treatment of basic emergencies and contribution to an ongoing health assessment thanks to the local diagnosis of the community 30. According to regulation nº 648 from March 2006, among the roles of the CHW is the sign u of all the eole in its area of work, the identification of family risk and the tutoring regarding how to use the available health care services. In this research, such tasks were more associated to the CHW category, though they were also detected among the tasks of the dental auxiliaries 4. The sign u of the families, erformed during the home visitation by the CHW, rovides a real understanding of the living conditions of the families that live in the area where the family health care team acts. When erforming this task, the CHW raises the main health issues of the families. This contributes to a directed attention to the actual demands of the families regarding its common roblems 29.

6 Rev Odontol UNESP. 2013; 42(5): Dental auxiliaries versus community health workers 355 The develoment of health awareness routines, health education and community mobility erformances were detected on both categories, with no statistical difference. This result suggests that once integrated to the family health care team end u integrated to the community as well. And thus acquire new roficiencies and abilities, such as require the solution for community roblems that affect the family health environment. All these erformances must be art of the daily routine of the family health care teams and are duties of every single team member 7. Thereby, the oulation may be taught to detect challenges and rovide tools to face them through the emowering of the eole. On regard to the activities on a clinical environment, this task was associated to the dental auxiliaries, as was the erformance of clinical rocedures and disinfection and sterilization of clinical instruments. An exected result, given this category is certified to rovide health assistance. However, some CHWs (33.6%) were deviated from their original attributions by erforming on clinical environment. The resent study has its limitations. Since it is based on collecting data through a questionnaire, there is a ossibility of information/recall bias that may comromise the accuracy of the information rovided by the research subjects. CONCLUSION As for the characterization of workers, dental auxiliaries are all female, have higher average age, more years of working for the ublic sector and most resented certification in their field of work. Regarding the tasks erformed on the ESF, desite the similarities in imortant tasks such as health conditions awareness and teamwork analysis, the categories resented contrasts in the family and clinical contexts. The dental assistant was associated to restricted tasks on the clinical environment, unlike the CHW, who is issued a greater amount of tasks on the family environment. On the subject of differences, in none of the tasks there was lack of articiation of the categories, however, the results of the collective erformances towards education and community mobility for the dental auxiliaries demonstrated the need of greater articiation from this category, since nearly half of these workers do not take art on these tasks. On the other hand, it also seems that it is necessary to evaluate the reasons for the lack of CHW involvement in tasks erformed on a clinical environment, since the lack of certification in their field of work may have a negative imact on the quality of the health care rovided. The effective attendance of the dental auxiliaries on health conditions awareness, teamwork analysis, education and community mobility tasks demonstrate that, desite having secific roles on clinical environment, once integrated to the family health care team, these workers undergo a shift in their ractice, working alongside the community and the families. Identifying the in-service training may have contributed to the ercetion of readiness to erform on the SUS and to the acquisition of roficiency and abilities needed for family health care. REFERENCES 1. Oliveira EM, Siri WC. Programa Saúde da Família: a exeriência de equie multirofissional. Rev Saúde Pública. 2006;40(4): htt://dx.doi.org/ /s Santos KT, Saliba NA, Moimaz SAS, Arcieri RM, Carvalho ML. Agente comunitário de saúde: erfil adequado a realidade do Programa Saúde da Família. Ciênc Saúde Colet. 2011;16(Sul 1): PMid: htt://dx.doi.org/ /s Pereira CRS, Roncalli AG, Cangussu MCT, Noro LRA, Patrício AAR, Lima KC. Imacto da Estratégia Saúde da Família sobre indicadores de saúde bucal: análise em municíios do Nordeste brasileiro com mais de 100 mil habitantes. Cad Saúde Pública. 2012;28(3): htt://dx.doi.org/ /s x Brasil. Portaria nº 648 de 28 de março de Arova a Política Nacional de Atenção Básica, estabelecendo a revisão de diretrizes e normas ara a organização da Atenção Básica ara o Programa Saúde da Família (PSF) e o Programa Agentes Comunitários de Saúde (PACS). Diário Oficial da União 2006; 29 mar. 5. Ferreira MEV, Schimith MD, Caceres NC. Necessidades de caacitação e aerfeiçoamento dos rofissionais de equies de saúde da família da 4ª Coordenadoria Regional de Saúde do Estado do Rio Grande do Sul. Ciênc Saúde Colet. 2010;15(5): htt://dx.doi. org/ /s Costa SM, Araújo FF, Martins LV, Nobre LLR, Araújo FM, Rodrigues CAQ. Agente Comunitário de Saúde: elemento nuclear das ações em saúde. Ciênc Saúde Colet [citado em 2013 Maio 12]. Disonível em: htt:// h?id_artigo= Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Deartamento de Atenção Básica. Política Nacional de Atenção Básica. Brasília: Ministério da Saúde; Paranhos LR, Tomasso S, Ricci ID, Siqueira DF, Scanavini MA. Atribuições e imlicações legais dos rofissionais auxiliares da odontologia: visão do rório auxiliar. RGO Rev Gaúcha Odontol. 2009;57(1): Queluz DP. Perfil dos rofissionais auxiliares da odontologia e suas imlicações no mercado de trabalho. Rev Odonto Ciência. 2005;20(49): Linan MBG, Bruno LENB. Trabalho e formação rofissional do atendente de consultório dentário e do técnico em higiene dental. Trab Educ Saúde. 2007;5(2): htt://dx.doi.org/ /s

7 356 Costa, Araújo Rev Odontol UNESP. 2013; 42(5): Brasil. Lei no , de 10 de julho de Cria a rofissão de agente comunitário de saúde e dá outras rovidências. Brasília: Ministério da Saúde; Brasil. Ministério da Saúde. Secretaria Executiva. Programa Agentes Comunitários de Saúde (PACS). Brasília: Ministério da Saúde; De Barros DF, Barbieri AR, Ivo ML, Da Silva MG. O contexto da formação dos agentes comunitários de saúde no Brasil. Texto & Contexto Enferm. 2010;19(1): htt://dx.doi.org/ /s Brasil. Lei nº de 24 de dezembro de Regulamenta o exercício das rofissões de Técnico em Saúde Bucal - TSB e de Auxiliar em Saúde Bucal ASB [citado em 2013 Maio 12]. Disonível em: htt:// 15. Girardi SN, Fernandes Júnior H, Carvalho CL. A regulamentação das rofissões de saúde no Brasil. Esaç Saúde (Online). Disonível em: htt:// 16. Oliveira AR, Chaves AEP, Nogueira JA, Sá LD, Collet N. Satisfação e limitação no cotidiano de trabalho do agente comunitário de saúde. Rev Eletr Enferm. 2010;12(1): Fonseca AF, Stauffer AB, organizadores. O rocesso histórico do trabalho em saúde. Rio de Janeiro: EPSJV/Fiocruz; Brasil. Ministério da Saúde. Ministério da Educação. Referencial curricular ara curso técnico de agente comunitário de saúde: área rofissional saúde/ Ministério da Saúde, Ministério da Educação. Brasília: Ministério da Saúde; Pedrosa JIS, Teles JBM. Consenso e diferenças em equies do Programa Saúde da Família. Rev Saúde Pública. 2001;35(3): htt:// dx.doi.org/ /s Camelo SHH, Angerami ELS. Formação de recursos humanos ara a estratégia de saúde da família. Ciênc Cuid Saúde. 2008;7(1): Brasil. Ministério da Saúde. Normas e diretrizes do rograma de agentes comunitários de saúde, PACS, Portaria nº 1886/GM. Anexo 1. Brasília: Ministério da Saúde; Brasil. Secretaria de Gestão do Trabalho e da Educação na Saúde. Deartamento de Gestão da Educação na Saúde. Políticas de Formação e Desenvolvimento ara o SUS: Caminhos ara a educação ermanente em saúde. Brasília: Ministério da Saúde; Ceccim RB. Educação Permanente em Saúde: descentralização e disseminação de caacidade edagógica na saúde. Ciênc Saúde Colet. 2005;10(4): htt://dx.doi.org/ /s Loes SRS, Piovesan ETA, Melo LO, Pereira MF. Potencialidades da educação ermanente ara a transformação das ráticas de saúde. Comun Ciênc Saúde. 2007;18(2): Filgueiras AS, Silva ALA. Agente Comunitário de Saúde: um novo ator no cenário da saúde do Brasil. Physis. 2011;21(3): htt:// dx.doi.org/ /s Nascimento EPL, Correa CRS. O agente comunitário de saúde: formação, inserção e ráticas. Cad Saúde Pública. 2008;24(6): htt://dx.doi.org/ /s x Albuquerque ABB, Bosi MLM. Visita domiciliar no âmbito da Estratégia Saúde da Família: erceções de usuários no Municíio de Fortaleza, Ceará, Brasil. Cad Saúde Pública. 2009;25(5): htt://dx.doi.org/ /s x Sakata KN, Almeida MCP, Alvarenga AM, Craco PF, Pereira MJB. Conceções da equie de saúde da família sobre as visitas domiciliares. Rev Bras Enferm. 2007;60(6): htt://dx.doi.org/ /s Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Deartamento de Atenção Básica. O trabalho do Agente Comunitário de Saúde. Brasília: Ministério da Saúde; Harris MJ, Haines A. The otential contribution of community health workers to imroving health outcomes in UK rimary care. J R Soc Med. 2012;105(8): htt://dx.doi.org/ /jrsm CONFLICTS OF INTERESTS The authors declare no conflicts of interest. CORRESPONDING AUTHOR Simone de Melo Costa UNIMONTES Universidade Estadual de Montes Claros, Rua Dr. Valmor de Paula, 27, Vila Regina, Montes Claros, MG, Brasil smelocosta@gmail.com Received: June 7, 2013 Acceted: Setember 2, 2013